A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase the duration of survival, or ultimately improve the chance of cure. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.
The following is a general overview of high-dose chemotherapy and autologous stem cell transplant for the treatment of inflammatory breast cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied to your situation. In addition to this treatment overview, the Cancer Treatment News web site feature presents the results of the actual clinical trials that determine the standard treatments of breast cancer and new treatment strategies as they have been discovered and applied by cancer physicians around the world.
All new treatments are developed in clinical trials. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of breast cancer. Remember, this web site information is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.
Inflammatory breast cancer is a specific kind of breast cancer that is characterized by specific changes in the breast. Inflammatory cancers typically have large areas of skin changes or indurations and are characterized on biopsy as having subdermal lymphatic invasion by cancer. Traditional treatment of inflammatory breast cancer includes the use of chemotherapy, radiation, surgery and hormonal therapy. Various combinations of these treatments have resulted in approximately 30% of patients with inflammatory breast cancer surviving greater than 5 years without cancer recurrence.
High-dose chemotherapy and autologous stem cell transplantation has been incorporated into the overall treatment of women with inflammatory breast cancer. Several small clinical trials were published in 1998-99 that reported the results of incorporating high-dose chemotherapy into the overall treatment strategy of patients with inflammatory breast cancer. In general, patients were treated with a sequence of low-dose induction chemotherapy followed by high-dose chemotherapy and mastectomy, radiation and hormonal treatment with tamoxifen. Some doctors have performed mastectomy after induction chemotherapy instead of after high-dose chemotherapy. Approximately 64% of patients are reported to survive without recurrence of their cancer 2 1/2 to 3 years from treatment. Recently, doctors from France have reported 57% cancer-free survival rates 5 years from treatment with no patients relapsing after 3 years.
Doctors from a single hospital have reported their results of treatment of patients with inflammatory breast cancer with aggressive non-standard chemotherapy and high-dose chemotherapy and autologous stem cell transplant. They then adopted an approach using high-dose chemotherapy. When they compared the results of the intensive chemotherapy and high-dose chemotherapy approaches, patients treated with high-dose chemotherapy appeared to have a better outcome. Seventy-six percent of patients treated with high-dose chemotherapy were alive without cancer recurrence compared to 58% of patients treated with non-high-dose chemotherapy 4 years from treatment. Since inflammatory breast cancer accounts for 1-4% of all breast cancers, large clinical trials comparing one treatment strategy to another have not been and are unlikely to ever be performed.
The main reason patients with inflammatory breast cancer fail treatment is relapse. Relapse of inflammatory breast cancer occurs locally in the breast or distantly. Distant relapse occurs because the high-dose chemotherapy is either unable to kill all the cancer cells in the patient and/or because cancer cells "contaminating" the stem cells are infused back into the patient. The majority of distant relapses occur because all the cancer cells were not destroyed by the high-dose chemotherapy treatment. However, some relapses may be due to infusion of breast cancer contaminated stem cells. Local relapse occurs because the surgery and radiation were unable to destroy the cancer cells in the breast. Doctors are performing clinical trials designed to improve the treatment of breast cancer with high-dose chemotherapy that include the following approaches alone or in combination: